title: Outcomes following renal transplantation in patients with chronic hepatitis C based on severity of fibrosis on pre-transplant liver biopsy.
abstract: Data regarding long-term outcomes following renal transplantation in patients with hepatitis C virus (HCV) infection have been controversial. Our aim was to determine whether there is a difference in outcomes between patients with HCV and more advanced fibrosis on pretransplant biopsy and those with minimal or no fibrosis. Patients were divided according to the severity of fibrosis and their outcomes (including acute rejection, chronic rejection, re-initiation of dialysis, progression of liver disease and mortality) were compared. Thirty-one patients with minimal or no fibrosis (Scheuer stages 0 and 1: Group-A) and 10 patients with more advanced fibrosis (Scheuer stages 2 and 3: Group-B) were included in the final data analysis. Acute rejection occurred in 29% (9/31) of the patients with minimal and 30% (3/10) of the patients with advanced fibrosis (P = 0.95), while chronic allograft nephropathy occurred in 6.5% (2/31) of the patients without and 50% (5/10) of the patients with fibrosis (P = 0.006). None of the patients without fibrosis required re-initiation of dialysis compared with 50% (5/10) of the patients with fibrosis (P <0.05). Median graft survival was 46 months and 18 months for patients with minimal and advanced fibrosis, respectively. There were four deaths among patients with advanced and three deaths among patients with minimal fibrosis (P = 0.04). Our data suggests that patients with chronic HCV and more advanced fibrosis on liver biopsy who undergo a renal transplant have a higher incidence of chronic rejection, graft failure and mortality following renal transplant compared with those with minimal fibrosis.
authors.affiliation: Methodist Transplant Institute, The University of Tennessee Health Sciences Center, Memphis, TN, USA. ndbouk@uthsc.edu
authors.forename: Nader
authors.initials: N
authors.lastname: Dbouk
authors.forename: Samir
authors.initials: S
authors.lastname: Parekh
mesh_terms: D001706:Biopsy; D005260:Female; D005355:Fibrosis; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome